公共卫生研究摘要 (2025-09-26)
共收录 56 篇研究文章
1. Advocacy for State Acknowledgment of the 2023 Brain Death/Death by Neurologic Criteria Guidelines as the Accepted Medical Standards.
期刊: Neurology 发表日期: 2025-Oct-21 链接: PubMed
摘要
State death determination acts require brain death/death by neurologic criteria (BD/DNC) determination to be in accordance with “accepted medical standards.” The American Academy of Neurology/American Academy of Pediatrics/Child Neurology Society/Society of Critical Care Medicine published updated BD/DNC guidelines in October 2023 to replace earlier iterations of separate guidelines for BD/DNC determination in adults and pediatric persons. There are no other medical society guidelines for BD/DNC determination in the United States. As of early 2024, only Nevada, New Jersey, and New York identified the 2023 BD/DNC guidelines as the “accepted medical standards.” Delineation of the “accepted medical standards” in state death determination acts or by state health organizations (SHOs) could help facilitate consistency and accuracy in BD/DNC determination, prevent false-positive death determination, and promote public trust. SHOs are comprised of policy experts and medical professionals responsible for addressing medical, ethical, and legislative problems related to health. In April 2024, we began iteratively contacting state health departments, medical boards, medical societies, and hospital associations requesting acknowledgment of the 2023 BD/DNC guidelines as the “accepted medical standards.” From April 2024 to March 2025, we contacted 168 SHOs and received responses from 108 of 168 (64%, median: 2 per state, range: 0-4 per state). The effects of this advocacy effort continue to evolve, but as of March 31, 2025, 4 states had an SHO that acknowledged the 2023 BD/DNC guidelines as the “accepted medical standards” (Delaware, Louisiana, Oklahoma, and Vermont), 9 states had an SHO discussing acknowledgment, 4 states had an SHO that would consider a resolution submitted by a member about acknowledgment, and 30 states showed no SHO interest in acknowledgment. The Medical Society of Delaware and the Oklahoma State Medical Association formalized acknowledgment in a resolution while the Louisiana Department of Health and the Vermont Department of Health and Board of Medical Practice disseminated communication about acknowledgment. This effort also prompted discussion about the “accepted medical standards” by the American Medical Association. Ongoing advocacy may expand recognition of the 2023 BD/DNC guidelines as the “accepted medical standards” for BD/DNC determination. Communication to hospitals indicating that adherence to these guidelines is crucial and regulations to ensure adherence are essential.
2. Association between nutritional status and cognitive function scores of adolescent girls in underprivileged communities.
期刊: International journal of adolescent medicine and health 发表日期: 2025-Sep-29 链接: PubMed
摘要
Optimal cognitive development in early life is crucial for academic achievement and long-term quality of life. However, there is limited and inconsistent evidence regarding its association with nutritional status, especially among underprivileged school-aged children and adolescent girls. This study aimed to assess the association between nutritional status and cognitive function among adolescent girls aged 11 to 17 years. A cross-sectional study was conducted among 372 adolescent girls from two schools in Takalar District between July and November 2024. Data collection included questionnaires, 24-h dietary recall, anthropometric measurements, and cognitive function assessments using the Culture Fair Intelligence Test (CFIT). Multivariate regression analysis was used to identify independent predictors of cognitive function. The mean age of participants was 14.0 ± 1.5 years. The prevalence of stunting, wasting, and chronic energy deficiency (CED) was 18.0 , 11.3, and 19.9 %, respectively. Girls with CED and stunting had significantly lower cognitive scores than their counterparts (CED: 74.3 ± 13.8 vs. 78.8 ± 13.8; p<0.05; Stunting: 73.3 ± 12.6 vs. 79.0 ± 13.9; p<0.01). Regular intake of iron-folic acid (IFA) supplements was associated with higher cognitive scores (80.2 ± 13.1 vs. 77.0 ± 14.1; p<0.05). Multivariate regression analysis showed that BMI-for-age z-score (β=3.419; p<0.01), IFA intake (β=4.054; p<0.05), and height-for-age z-score (β=0.652; p<0.01) were significant predictors of cognitive performance. Nutritional status was significantly associated with cognitive function among adolescent girls in underprivileged communities. Targeted nutrition interventions may be critical in supporting cognitive development in this vulnerable population.
3. Daily Dietary Sodium Intake Among Clinical Trial Participants Recruited From a University Health System or a Federally Qualified Health Center: Secondary Analysis of Baseline Participant Characteristics.
期刊: JMIR cardio 发表日期: 2025-Sep-25 链接: PubMed
摘要
Efforts to improve diversity in clinical trials often prioritize recruitment based on broad demographic factors. This approach may overlook the influence of community context and health-related social needs on health behaviors, including sodium intake, a key modifiable risk factor for hypertension and cardiovascular disease. This study aims to assess the impact of enrollment site, sociodemographic factors, and health-related social needs on baseline dietary sodium intake among participants in a mobile health clinical trial aimed at lowering blood pressure. The myBPmyLife study is a prospective, randomized controlled trial evaluating a mobile health intervention to lower blood pressure through increased physical activity and lower sodium food choices. Participants with hypertension were recruited from a university health system and a federally qualified health center (FQHC). All participants completed a validated sodium screener at enrollment. Sociodemographic data and health-related social needs were self-reported. Univariable and multivariable linear regression models were used to evaluate the associations between sodium intake and participant characteristics. This analysis presents a cross-sectional examination of the baseline characteristics of participants enrolled in the myBPmyLife study. Among 600 included participants, 96 (16.0%) were from the FQHC. Mean age was 60.1 (SD 13.5) years; 48.2% (289/600) were women, and 13.0% (78/600) were Black. FQHC participants were significantly younger (mean age 47.9, SD 11.1 vs 62.5, SD 12.7 years), more likely to be Black (43/96, 44.8% vs 35/504, 6.9%), and 8.5 times more likely to have difficulty paying for their health-related social needs. Mean baseline sodium intake was 3082.3 (SD 1072.5) mg/day, with 85.5% (513/600) of participants exceeding the World Health Organization’s recommended daily sodium limit. Baseline sodium intake was significantly higher for FQHC participants (mean difference 381.1, SD 1064.2 mg/d; 95% CI 84.5-677.7; P=.01), men (mean difference 543.9, SD 1038.3 mg/d; 95% CI 377.3-710.5; P<.001), Black participants (mean difference 442.5, SD 1043.4 mg/d; 95% CI 119.7-765.3; P=.008) and those with difficulty affording basic needs (mean difference 338.1, SD 1066.7 mg/d; 95% CI 95.2-581.0; P=.02). Sodium intake was lower in older participants (-196.4 mg/d per 10 years; 95% CI -258.0 to -134.9; P<.001). In a multivariable analysis, age, gender, and race remained independently associated with sodium intake, while differences by site and health-related social needs were not statistically significant. Differences in sodium intake were observed across sociodemographic groups. While the enrollment site was not independently associated with sodium intake after adjustment, it played a role in shaping the participant population, evidenced by the differences in demographics and health-related social needs among participants based on enrollment site. These findings underscore the importance of recruiting from distinct clinical settings to capture a range of contextual factors that influence health behaviors. Clinical trials aiming for representativeness should consider both individual- and community-level factors during recruitment to more accurately inform interventions and health outcomes.
4. Assessing Work-Related Stressors in Online Counseling: Cross-Sectional Questionnaire Development Study.
期刊: JMIR formative research 发表日期: 2025-Sep-25 链接: PubMed
摘要
The rapid digitalization of health and social services, particularly accelerated by the COVID-19 pandemic, has led to a widespread adoption of online counseling. While offering flexibility and improved access for clients, online counseling presents new challenges for counselors, including technical issues, difficulties in building therapeutic relationships, and changes in work organization. Despite growing reliance on digital counseling platforms, there is a lack of validated tools to assess specific occupational stressors associated with online counseling. This study aimed to develop and evaluate the “QueStrOn” (Questionnaire to Assess Stressors in Online Counseling), an instrument designed to identify stressors and resources specific to online counseling and to explore its ability to predict perceived stress levels in counselors. Item development was guided by the Job Demands-Resources model, qualitative interviews with 22 counselors, expert input, and a literature review. A preliminary version of the questionnaire was pretested and then distributed via email and social media to counselors offering both online and face-to-face services. A total of 219 counselors completed the survey, and after applying inclusion criteria, 174 responses were analyzed. Exploratory factor analysis was conducted using principal axis factoring and varimax rotation. Internal consistency was assessed via Cronbach alpha (α). A linear regression model was used to initially test the predictive power of the identified factors with perceived digital stress as the dependent variable. The exploratory factor analysis resulted in a four-factor solution with 16 items, capturing (1) Online Work Organization, (2) Online Framework, (3) Online Work Content, and (4) Online Communication. The overall instrument demonstrated high internal consistency (α=0.870), with acceptable values for factors (1), (3), and (4) (α=0.754, 0.745, and 0.826, respectively), although the factor “Online Framework” showed limited reliability (α=0.502). The regression model, adjusted for age and gender, significantly predicted perceived stress in online counseling (F5=13.335, P<.001), explaining 27.1% of the variance. Online Work Organization, Online Communication, and Online Framework were associated with lower perceived stress when rated positively, whereas Online Work Content showed an inverse relationship, potentially reflecting emotional distancing. The QueStrOn instrument provides a valid first step toward systematically assessing occupational stressors in online counseling. Its 4-factor structure aligns with theoretical and empirical findings and offers practical utility for workplace risk assessments. Incorporating these dimensions into routine evaluations may support counselor well-being and inform digital health policy. Further validation and longitudinal studies are recommended to expand its applicability and explore associations with broader health outcomes.
5. Health Care Professionals' Knowledge, Attitude, Practice, and Infrastructure Accessibility for e-Learning in Ethiopia: Cross-Sectional Study.
期刊: JMIR medical education 发表日期: 2025-Sep-25 链接: PubMed
摘要
Training of health care professionals and their participation in continuous medical education are crucial to ensure quality health care. Low-resource countries in Sub-Saharan Africa struggle with health care disparities between urban and rural areas concerning access to educational resources. While e-learning can facilitate a wide distribution of educational content, it depends on learners’ engagement and infrastructure. This study aims to assess knowledge, attitude, practice, and access to infrastructure related to e-learning among health care professionals in primary health care settings in Ethiopia. In April 2023, we carried out a quantitative, questionnaire-based cross-sectional study guided by the knowledge, attitudes, and practice framework, including additional items on available infrastructure. The scores in each category are defined as “high” and “low” based on the median, followed by the application of logistic regression on selected sociodemographic factors. We included health care professionals working in general and primary hospitals, health centers, and health posts. Of 398 participants (response rate 94.5%), more than half (n=207, 52%) reported feeling confident about their understanding of e-learning and conducting online searches, both for general (n=247, 62.1%) and medical-related content (n=251, 63.1%). Higher levels of education were associated with better knowledge (adjusted odds ratio [AOR] 2.32, 95% CI 1.45-3.68). Regardless of financial and personal efforts, we observed a generally positive attitude. Almost half of the participants (n=172, 43.2%) reported using the internet daily, compared to 16.8% (n=67) of participants who never used the internet. Higher education (AOR 2.56, 95% CI 1.57-4.16) and income levels (AOR 1.31, 95% CI 1.06-1.62) were associated with higher practice scores of e-learning-related activities. Women, however, exhibited lower practice scores (AOR 0.44, 95% CI 0.27-0.71). Regular access to an internet-enabled device was reported by 43.5% (n=173) of the participants. Smartphones were the primarily used device (268/393, 67.3%). Common barriers to internet access were limited internet availability (142/437, 32.5%) and costs (n=190, 43.5%). Higher education (AOR 1.56, 95% CI 0.98, 2.46) and income (AOR 1.50; 95% CI 1.21-1.85) were associated with increased access to infrastructure, while it was decreased for women (AOR 0.48, 95% CI 0.30-0.77). Although Ethiopian health care professionals report mixed levels of knowledge, they have a positive attitude toward e-learning in medical education. While internet use is common, especially via smartphone, the access to devices and reliable internet is limited. To improve accessibility, investments in the digital infrastructure and individual digital education programs are necessary, especially targeting women and those with lower income. Due to their widespread availability, e-learning programs should be optimized for smartphones.
6. Identification and biological characteristics of Colletotrichum species causing persimmon anthracnose in China and screening of Colletotrichum horii antifungal agents.
期刊: Plant disease 发表日期: 2025-Sep-25 链接: PubMed
摘要
Persimmon anthracnose, caused by a diverse range of Colletotrichum species with genetic variations, poses a significant and widespread threat to persimmon cultivars. This study aimed to identify the causal agents via morphological characterization and multi-locus phylogenetic analysis, investigate their biological characteristics, and evaluate the efficacy of antifungal agents against the most virulent species. Six anthracnose isolates were identified: C. boninense, C. fioriniae, C. horii, C. gloeosporioides s.s, C. fructicola, and C. aenigma. All isolates were pathogenic to persimmon branches and leaves, with C. horii causing the largest leaf lesions and exhibiting strong pathogenicity on branches, resulting in severe infections on persimmon seedling leaves and branches. Beyond determining the pathogenicity of these Colletotrichum spp. on persimmons, this study also investigated the biological characteristics of the six anthracnose fungi, including optimal growth conditions for temperature, pH, light, and medium. The results showed that the optimal temperature for the growth of all six fungi was 25 °C, with no significant variation in the pH values ranging from four to ten. Light conditions significantly influenced sporulation: continuous darkness was most conducive to conidial formation and production, except for C. boninense. Mycelial growth of most species was insensitive to light, while C. boninense grew fastest under continuous light. In vitro screening of sixteen antifungal agents against C. horii revealed that Bacillus subtilis exhibited the strongest inhibitory activity against mycelial growth, followed by carbendazim, imidazole, thiophanate-methyl, pyraclostrobin, and difenoconazole. Field trials confirmed that imidazole, pyraclostrobin, and difenoconazole provided the most effective control of persimmon anthracnose. These findings provide a theoretical basis for understanding the epidemiology and developing management strategies for persimmon anthracnose.
7. A Culturally Tailored Digital Education Intervention to Improve Nutrition Among Older Adult Congregate Meal Participants During COVID-19: Protocol for a Stepped-Wedge Cluster Randomized Controlled Trial.
期刊: JMIR research protocols 发表日期: 2025-Sep-25 链接: PubMed
摘要
Inadequate nutrition and a lack of physical activity contribute to functional decline and complications from chronic diseases in older adults. The pandemic halted or altered necessary Older Americans Act (OAA) nutrition services provided to vulnerable, community-dwelling older adults in San Antonio, Texas. The “digital divide” or gap in technological access and knowledge further heightened the detrimental effect of the COVID-19 pandemic on older adults who may be “digitally excluded” from social, economic, and health-related interactions. During the pandemic, San Antonio congregate meal sites funded by OAA remained partially open biweekly to distribute meals but no longer offered in-person nutrition education, physical activity classes, and social activities. This project expands the current congregate meal programming infrastructure and partnerships with Older Adults Technology Services (OATS) to create a sustainable approach focused on improving the health of older adults. The study aims (1) to test the impact of a digital nutrition education intervention on the primary outcomes of food security and diet quality; (2) to determine the effect of the intervention on secondary outcomes of technology knowledge and usage, physical activity, and social isolation and loneliness; and (3) to examine the long-term impact and sustainability of technology use on food security, diet quality, physical activity, social isolation, and loneliness. This proposed digital nutrition education intervention study targets technologically limited older adults enrolled in the congregate meal program (CMP) using a stepped-wedge clustered randomized controlled trial. Key community partners, City of San Antonio Department of Health Services Senior Services Division and OATS, contributed to the study’s planning phase, research design, and implementation. The 20-week intervention included 5 weeks of in-person technology training, including internet access and technical support for 1 year and devices, followed by 15 weeks of a culturally tailored online nutrition education intervention. The study randomized 398 older adults from 12 congregate meal sites. Data collection took place at baseline, 3 months, 6 months, 9 months, 12 months, and 18 months. If successful, the impact of this program could be applied throughout the national OATS network and to similar CMPs to bridge the digital divide beyond the COVID-19 pandemic. Recruitment and enrollment of 398 older adults at 12 CMPs was completed in December 2022. Study CMPs were randomly assigned to Cohort 1 and 2: 164 completed Cohort 1 in August 2023 and 111 completed Cohort 2 in April 2024. Eighteen-month data collection is ongoing. This study aims to determine the impact of a digital nutrition intervention on older adults’ nutrition status, physical activity, loneliness and isolation, and technology access and usage. Results from this study can inform future interventions with vulnerable populations and may serve as a basis for other OAA nutrition services.
8. Mapping the Evolution of China's Traditional Chinese Medicine Education Policies: Insights From a BERTopic-Based Descriptive Study.
期刊: JMIR medical education 发表日期: 2025-Sep-25 链接: PubMed
摘要
Traditional Chinese medicine (TCM) education in China has evolved significantly, shaped by both national policy and social needs. Despite this, the academic community has yet to fully explore the long-term trends and core issues in TCM education policies. As the global interest in TCM continues to grow, understanding these trends becomes crucial for guiding future policy and educational reforms. This study used cutting-edge deep learning techniques to fill this gap, offering a novel, data-driven perspective on the evolution of TCM education policies. This study aimed to systematically analyze the research topics and evolutionary trends in TCM education policies in China using a deep learning-based topic modeling approach, providing valuable insights to guide future policy development and educational practices. TCM policy-related documents were collected from major sources, including the Ministry of Education, the National Administration of Traditional Chinese Medicine, PKU Lawinfo, and archives of TCM colleges. The text was preprocessed and analyzed using the BERTopic model, a state-of-the-art tool for topic modeling, to extract key themes and examine the policy development trajectory. The analysis revealed 27 core topics in TCM education policies, including medical education, curriculum reform, rural health care, internationalization, and the integration of TCM with modern education systems. These topics were clustered into 5 stages of policy evolution: marginalization, standardization, specialization, systematization, and restandardization. These stages reflect the ongoing balancing act between modernizing TCM education and preserving its traditional values, while adapting to national political, social, and economic strategies. This study offers groundbreaking insights into the dynamic and multifaceted evolution of TCM education policies in China. By leveraging the BERTopic model, it provides a comprehensive framework for understanding the forces shaping TCM education and offers actionable recommendations for future policy making. The findings are essential for educators, policymakers, and researchers aiming to refine and innovate TCM education in an increasingly globalized world.
9. Development and Internal Validation of the Multiethnic Type 2 Diabetes Outcomes Model for the U.S. (DOMUS).
期刊: Diabetes care 发表日期: 2025-Sep-25 链接: PubMed
摘要
The objective of this study was to develop and internally validate a mathematical model of the relationships between patient clinical and social risk factors and outcomes using data from a multiethnic population with type 2 diabetes. We constructed an incidence cohort of all adults (18 years or older) with newly diagnosed type 2 diabetes in the Kaiser Permanente Northern California (KPNC) health care system between 2005 and 2016 (n = 129,000), following patients for at least 1 year, but up to 12 years. Using this cohort, we modeled 17 distinct diabetes-related outcomes related to micro- and macrovascular disease, as well as atrial fibrillation, depression, dementia, relevant biomarkers, and mortality. Data were randomly split into 50%, 25%, and 25% samples to perform model estimation, calibration, and validation, respectively. Empirical and simulated data were similar for the events and biomarkers, but some factors required calibration. After calibration, they closely aligned with empirical estimates. The resulting Diabetes Outcome Model of the U.S. (DOMUS) is a major step forward in understanding diabetes progression and the role of social determinants of health. This model can be used by scientists, policymakers, and health system managers to better understand how choices can affect population health and health disparities, including the broad diversity of U.S. races and ethnicities. Moreover, this model can be used to realize longer-term comparative effectiveness in cost-effectiveness analyses for diabetes management in the future.
10. Burden of Travel is not Associated with Adherence to Follow-up Appointments - A Call for Centralization of Cleft Care in Germany.
期刊: The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association 发表日期: 2025-Sep-25 链接: PubMed
摘要
ObjectiveThe German system of care for patients with cleft lip and/or palate (CL/P) is fragmented. An argument against centralization is that the higher burden of travel for patients in remote and rural areas would reduce appointment adherence and subsequent care outcomes. Our objective was to test the association of travel burden and adherence and outline potential benefits of centralized cleft care.DesignFollow-up appointments June 2005 to August 2020 were retrospectively analyzed for patients with CL/P in a large German tertiary care center. Distance to care center and travel time by car/public transportation were calculated using Google Maps. Demographic characteristics included population density, degree of urbanization, and average disposable income per capita of the municipality of origin. Multiple regression models including flexible spatial function learning assessed associations with follow-up appointment adherence.ResultsPatients (n = 1140) had 9447 scheduled appointments with a 48.2% attendance rate. Distance to the clinic (M = 85.19 ± 75.12 km, range 0.45-536), travel time (M = 71.18 ± 48.5 min, range 2-330), population density (725.32 ± 807.82 inhabitants/km², range 14-4861), and lower average income (20,993.38 ± 1220.72 Euro, range 14,521-32,348.83) were not associated with appointment attendance. Patients from more rural areas were slightly more likely to attend check-ups (p = 0.027, 95% CI [0.016, 0.212]).ConclusionThe burden of travel to the clinic was not associated with attending follow-up appointments for patients with CL/P. These findings challenge a common assumption about attendance and warrant further multi-center studies to inform policy decisions for restructuring cleft care in Germany.
11. Recommended approaches to sharing individual research results in Alzheimer's disease research: A multidisciplinary expert Delphi consensus.
期刊: Journal of Alzheimer’s disease : JAD 发表日期: 2025-Sep-25 链接: PubMed
摘要
BackgroundAs criteria for diagnosing Alzheimer’s disease and Alzheimer’s disease related dementias (AD/ADRD) evolves, AD-related biological measures of biomarkers (e.g., amyloid, tau) and genetic status (e.g., APOE) have gained heightened value in research, and, notably, increased personal significance for participants.ObjectiveTo identify recommended approaches for sharing individual research results with participants in AD/ADRD research and determine expert consensus on best practices for sharing individual research results to participants in AD/ADRD research.MethodsThis online, modified Delphi study consisted of four rounds of surveys conducted with Alzheimer’s disease research experts, including neurologists, ethicists, neuropsychologists, geneticists, clinical trialists, and other research stakeholders. The Delphi survey was informed by a targeted literature review of previously published recommendations on sharing individual research results in AD/ADRD research. A total of 81 experts were surveyed across all rounds, ranking statements on a 7-point Likert scale and providing feedback in short answer responses. After each round, feedback reports were shared to inform subsequent responses. Proportion of agreement and qualitative feedback were analyzed, with consensus defined as 75% or greater agreement.Results41 initial statements were evaluated and refined based on consensus and feedback. Concluding the final round (round 3), consensus (≥75% agreement) was achieved on 25 statements, resulting in a set of recommendations related to: study design, clinical relevance, results sharing processes, communication and understanding of results, counseling and support, and follow-up.ConclusionsThe findings of this online, modified Delphi study provide a foundation for developing standardized, ethically grounded practices for returning individual research results in Alzheimer’s disease studies.
12. The EPA's shaken foundation.
期刊: Science (New York, N.Y.) 发表日期: 2025-Sep-25 链接: PubMed
摘要
The US Environmental Protection Agency (EPA) was founded in 1970 during a period of pervasive pollution and environmental degradation. Based on a foundational principle to follow the science, its Office of Research and Development (ORD) has since developed and translated science to inform decisions that protect human health and the environment. Yet, even with many environmental challenges to address, ORD was eliminated by the Trump administration in July. Cutting the legs off a science-based agency, as well as the paucity of information about how ORD would be absorbed into policy or political parts of the agency, raises concerns that fundamental, long-term research and innovation will suffer and that EPA science will be vulnerable to political interference. This could affect national and global science for years to come.
13. What if NIH had been 40% smaller?
期刊: Science (New York, N.Y.) 发表日期: 2025-Sep-25 链接: PubMed
摘要
Replaying history with less NIH funding shows widespread impacts on drug-linked research.
14. Cognitive Behavioral Therapy for Insomnia May Improve Sleep and Pain in Crohn's Disease: A Waitlist Control Pilot Trial.
期刊: Inflammatory bowel diseases 发表日期: 2025-Sep-25 链接: PubMed
摘要
Poor sleep is common in Crohn’s disease (CD), prospectively predicts worse disease course, and is often attributable to insomnia. Cognitive behavioral therapy for insomnia (CBT-I) is the recommended treatment for chronic insomnia disorder. CBT-I improves sleep and may improve pain intensity, pain interference, and inflammation. We sought to investigate whether CBT-I impacts these factors in patients with active CD. We recruited patients with insomnia and mild-to-moderate CD symptoms from an inflammatory bowel disease center. Exclusion criteria were other sleep disorders, significant psychiatric concerns, and presence of other common influences on sleep. Participants completed baseline assessments of sleep, pain, and inflammation then were randomized to receive CBT-I immediately, or wait 12 weeks and then repeat the baseline assessment and complete CBT-I. Similar assessments occurred immediately post-CBT-I and 1 month later. CBT-I included sleep restriction, stimulus control, sleep hygiene, arousal reduction, and cognitive therapy. A total of 26 participants completed the study. In group × time analyses, CBT-I led to greater reductions in insomnia severity (P < .001) and wake after sleep onset (P = .02) than waitlist. In pre- to post-treatment analyses, participants reported significant improvements in subjective measures of sleep continuity, CD symptom severity, pain intensity, and pain interference. C-reactive protein trended toward improvement. This study provides preliminary evidence of efficacy of CBT-I in people with CD. CBT-I improved self-reported sleep and may improve pain and CD symptoms. The results highlight the importance of addressing sleep concerns in inflammatory bowel disease, particularly in people with persistent pain or fatigue. Future trials powered to detect changes in pain and inflammation are warranted. Insomnia disorder is a common problem in people with Crohn’s disease (CD). We demonstrated that cognitive behavioral therapy for insomnia is effective for treating sleep problems in CD. Treatment also may improve pain intensity, pain interference, and self-reported CD symptoms.
15. Impact of a Longitudinal Virtual Education Series on Home Dialysis Education: A Mixed-Methods Evaluation.
期刊: Clinical journal of the American Society of Nephrology : CJASN 发表日期: 2025-Sep-25 链接: PubMed
摘要
Home dialysis has clinical and economic benefits, yet it remains underutilized in the United States. One barrier is a lack of experience amongst fellows due to inadequate training. To enhance fellow training, the American Society of Nephrology launched the Home Dialysis Virtual Longitudinal Education Program (ASN-HDU) with Home Dialysis University (HDU) in 2023. We evaluated the ASN-HDU longitudinal program using mixed-methods. We sampled participants from two groups: (1) fellows who attended both HDU and the ASN virtual program, and (2) fellows who only attended HDU. We sent a post-HDU survey and eight-month follow-up survey to assess quantitative changes in comfort in home dialysis. We interviewed participants from both groups and used a constant comparative method to identify qualitative themes related to home dialysis training. After attending HDU, 52 participants reported median comfort levels of 7-8 out of 10 for peritoneal dialysis (PD) topics, and 4-5 out of 10 for home hemodialysis topics. In the follow-up survey, only participants of ASN-HDU demonstrated significant improvement in comfort level for all home dialysis topics by 1-2 out of 10 (except volume overload management on PD). Two main themes emerged from 10 qualitative interviews: (1) home dialysis training is sporadic and lacks structure, with subthemes describing challenges with receiving hands-on training, lack of systematic training, and a need for fellows to create their own training pathways, and (2) HDU and ASN-HDU are structured curricula that fill many educational gaps, but not all, with subthemes describing the value of these programs, examples of how fellows apply knowledge gained in clinical practice, and gaps that these curricula cannot directly address. Participation in ASN-HDU was associated with improved fellow comfort levels in home dialysis. Both HDU and ASN-HDU help address several gaps in home dialysis training in fellowship programs, but trainees may benefit from additional hands-on clinical experience.
16. Timed Up-and-Go Test with an Obstacle: Evaluating Anticipatory Locomotor Adjustments in Older Adults.
期刊: Journal of motor behavior 发表日期: 2025-Sep-25 链接: PubMed
摘要
The Timed Up-and-Go (TUG) test, a clinical assessment tool of functional mobility and balance scale for fall risk, is potentially helpful for evaluating anticipatory locomotor adjustments (ALA). This study aimed to simplify ALA evaluation in older adults using the TUG test. Thirty-eight older adults (mean ± SD: 74.97 ± 6.42 years) and 24 younger adults (25.16 ± 4.82 years) participated. Two identical poles replaced the cone-shaped object, creating the “obstacle TUG (Obs-TUG) test.” Participants chose between passing between the poles or detouring around them. We examined the quality of ALA in terms of their route selection. Results showed that older adults selected a detour more frequently than younger adults, even if the opening between the two poles was so wide that passing through the opening required less time than taking a detour. Older adults were characterized by shorter step lengths and narrower step widths while turning, indicating prioritization of stability over efficiency. The Obs-TUG test effectively describes ALA characteristics in older adults through consistent behavioral choices in route selection and walking patterns.
17. Epitranscriptomic sculpting: the role of m6A in alternative splicing, cancer progression, and methodological insights.
期刊: Medical oncology (Northwood, London, England) 发表日期: 2025-Sep-25 链接: PubMed
摘要
The burgeoning field of epitranscriptomics -modifications of RNA molecules that do not alter the underlying RNA sequence but affect gene expression- has unveiled m6A as a pivotal modulator of RNA fate, with profound implications for alternative splicing and cancer progression. This review synthesizes current evidence delineating the molecular mechanisms by which m6A deposition influences spliceosomal dynamics and RNA processing. Central to this process is the coordinated action of m6A “writers,” “erasers,” and binding proteins (“readers”), which collectively dictate transcriptome diversity through precise modulation of splicing decisions. Aberrant m6A modifications have been increasingly correlated with dysregulated splicing patterns that contribute to oncogenic transformation, tumor heterogeneity, and the emergence of aggressive cancer phenotypes. By integrating findings from recent studies, this article highlights the critical interplay between epitranscriptomic regulation and the alternative splicing machinery, underscoring how these interactions drive pathophysiological processes in cancer. Furthermore, the review explores emerging therapeutic opportunities targeting the m6A regulatory network, calling attention to its potential as both a prognostic biomarker and a novel intervention point in precision oncology. Through a comprehensive examination of the current literature, this analysis provides valuable insights into the role of m6A in sculpting the cancer transcriptome, offering a robust framework for future research endeavors in the field of cancer biology and therapeutic innovation.
18. Predictive value of Shanghai score system in patients with drug-induced type 1 Brugada electrocardiographic pattern.
期刊: Clinical research in cardiology : official journal of the German Cardiac Society 发表日期: 2025-Sep-25 链接: PubMed
摘要
The Shanghai score system was developed to enhance the risk stratification in Brugada Syndrome (BrS); however, its prognostic value in drug-induced type 1 BrS remains unclear. This study involved 698 patients with drug-induced type 1 BrS, confirmed via pharmacologic challenge (flecainide or ajmaline), from 21 centers in Italy and Switzerland. Patients were classified according to the Shanghai score system: probable/definite BrS (score ≥ 3.5) and possible BrS (score < 3.5). The primary outcome was appropriate ICD therapy or sudden cardiac death (SCD)/sustained ventricular arrhythmias; the secondary outcome includes the identification of clinical predictors of primary outcome events. Kaplan-Meier and Cox regression analyses were used. Our study population included 239 patients (34.2%) with probable/definite BrS and 459 (65.8%) patients with possible BrS. During a median follow-up of 57.4 months, 20 patients (2.9%) experienced the primary outcome. Kaplan-Meier analysis revealed a significantly lower event rate in possible BrS (0.11% over 10 years) compared to probable/definite BrS (0.42%). SCN5A pathogenic variants were a significant predictor of primary endpoint in the possible BrS group (OR: 12.5). Shanghai score system for BrS diagnosis may be useful as a tool for risk stratification of life-threatening arrhythmias among patients with drug-induced type I BrS ECG. Identifying the SCN5A mutations is of pivotal importance for refining the risk stratification.
19. Longitudinal Findings From a Land-Based HIV Prevention Study With Northern and Indigenous Youth, Canada.
期刊: Health promotion practice 发表日期: 2025-Sep-25 链接: PubMed
摘要
The high prevalence of sexually transmitted infections (STIs) in the Northwest Territories (NWT), Canada underscores the need for culturally relevant, community-driven sexual health initiatives for HIV and STI prevention that prioritize youth engagement and Indigenous leadership. FOXY (Fostering Open eXpression among Youth), a Northern and Indigenous NWT-based community-based organization, conducted 1-week youth Peer Leader Retreats (PLRs) focused on HIV prevention and leadership using land- and arts-based approaches. We conducted a one-group pretest/posttest with youth PLR participants aged 13 to 17 in the NWT and combined the data across PLRs conducted from 2020 to 2022. Assessments were completed at preretreat baseline, immediately postretreat, and at 6-month follow-up to measure changes in study outcomes (safer sex self-efficacy [SSSE], condom use self-efficacy [CUSE], and HIV knowledge). Of n = 133 participants at baseline, 6-month follow-up data were available for n = 122 (92%) participants. Multivariate analyses showed significant improvements in all study outcomes from baseline to 6-month follow-up. SSSE, CUSE, and HIV knowledge scores increased postretreat and continued to improve at 6 months. These findings suggest that culturally relevant, community-driven peer leadership interventions hold promise in advancing HIV prevention cascade outcomes with Northern and Indigenous youth in the NWT.
20. Evidence-Based Social Marketing Campaign With Social Contact to Address Stigma Associated With Substance Use and Support for Harm Reduction in Indiana.
期刊: Health promotion practice 发表日期: 2025-Sep-25 链接: PubMed
摘要
Stigma, or the negative beliefs and attitudes surrounding substance use disorders, is a complex process that acts as a barrier to expanding harm-reduction services. Communication campaigns with educational and social contact components show promise in addressing stigma but are similarly complex and require defining which existing community views to target and with what content. To this end, we leveraged a social marketing approach to integrate evidence on stigmatizing views from the community with expertise from academic researchers and product development from a marketing firm for the Connection is Hope: End Stigma campaign in Fayette County, Indiana. The resulting 6-month marketing plan included two components: social media (Facebook) and social contact (in-person networking and social events). Awareness of and information-seeking on harm-reduction activities in Fayette County and positive feedback to campaign products increased over the course of the campaign despite low implementation fidelity of the social contact component. A social marketing approach shows promise in triangulating expertise to create awareness for substance use and harm-reduction services, which can address inaccurate beliefs leading to stigma. However, triangulating expertise requires increased attention to participatory decision-making to ensure community ownership and create opportunities for positive social contact.
21. Testing the Acceptability and Feasibility of a Gender-Informed Smoking Cessation mHealth App for Women: Mixed Methods Approach.
期刊: JMIR human factors 发表日期: 2025-Sep-25 链接: PubMed
摘要
Cigarette smoking is a leading cause of preventable morbidity and mortality worldwide. Women who smoke face greater health risks than men, including higher rates of cardiovascular disease and more pronounced declines in lung function. Despite this, women experience lower success rates with conventional smoking cessation treatments, due in part to unique sex- and gender-related factors influencing smoking behavior and barriers to quitting. Digital health tools, such as mobile health apps, offer a promising avenue for delivering accessible, tailored smoking cessation support to women. This study evaluated the acceptability and feasibility of the “My Change Plan-Women” (MCP-W) app, a gender-specific smoking cessation mobile health intervention co-designed with women who smoke, clinicians, and researchers, to address women’s unique needs in smoking cessation. We conducted a single-group, prospective, sequential mixed methods study with 30 women who smoke in Ontario, Canada. Participants used the MCP-W app for 28 days. Acceptability was defined as ≥50% of participants endorsing “agree” or “strongly agree” to the statement “using the app is likely to help me make changes to my smoking habits.” Feasibility was defined as ≥50% of participants using the app for 7 or more days during the trial period. Quantitative data on acceptability, smoking behavior, and motivation to quit were collected at baseline and follow-up via REDCap (Research Electronic Data Capture) surveys. App usage metrics were captured through Google Analytics. Semistructured interviews explored participants’ experiences using the app and were thematically analyzed using the theoretical framework of acceptability. At follow-up, 37% (11/30; 95% CI 21%-56%) of participants rated the MCP-W app as acceptable, falling below the predefined threshold (≥50%) and indicating that the intervention “needs further work.” Feasibility criteria were met, with 60% (18/30) of participants using the app for 7 or more days. Notably, acceptability was higher among those who used the app for more than 14 days (7/11, 64%) compared with those with lower usage (4/19, 21%). Average daily cigarette consumption decreased from 16.4 to 14.6 cigarettes, and the number of participants reporting at least 1 smoke-free day in the previous week increased from 7% (2/27) to 22% (6/27). Qualitative findings revealed that women with higher motivation to quit found the app more helpful, particularly its behavior change tools (eg, cigarette tracking and identifying triggers) and gender-specific content. However, women facing stress, mental health challenges, or low readiness found it harder to engage. Participants suggested enhancements including customizable reminders, more interactive content, and live or artificial intelligence-based emotional support. The MCP-W app is a feasible intervention for delivering gender-specific smoking cessation support. However, its acceptability was limited to a third of users with high levels of motivation. Improvements to interactivity and support features may enhance its relevance and uptake among women with complex barriers to quitting.
22. Population-attributable fractions for modifiable risk factors across the continuum of cognitive decline: Hubei Memory and Aging Cohort Study.
期刊: Journal of Alzheimer’s disease : JAD 发表日期: 2025-Sep-25 链接: PubMed
摘要
BackgroundThe increasing prevalence of dementia, especially in nations such as China, emphasizes the importance of targeting modifiable risk factors for primary prevention. However, the extent to which these factors contribute to the population-attributable fractions (PAFs) across the spectrum of cognitive decline remains unclear.ObjectiveThis study aimed to investigate changes in risk factors along the dementia continuum and identify common risk factors by constructing PAFs for subjective cognitive decline (SCD), mild cognitive impairment (MCI), and dementia among older adults in rural and urban China.MethodsWe present a cross-sectional analysis of data from the 2018-2023 rounds of the dongoing Hubei Memory and Aging Cohort Study, including 8827 Chinese older adults (mean age 72.5 ± 5.9 years, 55.2% female, and 37.3% rural residents). We calculated the weighted population attributable fraction (PAFs) of 22 modifiable risk factors for SCD, MCI, and dementia, which included the 12 risk factors for dementia in the model of the 2024 Lancet Commission and 10 new factors.ResultsUsing data from 8827 Chinese older adults, we revealed that an estimated 22.87%, 39.00%, and 60.15% of the individuals with SCD, MCI, and dementia, respectively, were associated with 22 modifiable risk factors. We identified 10 shared modifiable risk factors that accounted for SCD (20.83%), MCI (24.12%), and dementia (42.26%). Additionally, the rural residents exhibited greater weighted PAFs across the cognitive decline continuum than urban residents. However, we did not observe significant sex differences in these associations.ConclusionsPAFs of risk factors vary substantially across the cognitive decline continuum.
23. Comparison of Self-Reported Intake Versus Military Dietary Reference Intakes in Deployed Special Operations Forces Soldiers.
期刊: Military medicine 发表日期: 2025-Sep-25 链接: PubMed
摘要
Special Operations Forces (SOF) Soldiers are elite warfighters who have high nutritional requirements based on the rigorous nature of their training and deployments. Inadequate nutrition can lead to diminished health and performance. Energy and nutrient guidelines for military personnel are defined in the Military Dietary Reference Intakes (MDRI). It is not known if SOF Soldiers meet the MDRIs during deployment when physical demands are high and access to quality nutrition may be limited. The objective of this study was to compare self-reported intake with established MDRIs in SOF personnel during a deployment in an austere environment. This was a cross-sectional study who was conducted at the end of a 6-month deployment in Afghanistan. Active duty SOF male Soldiers (n = 40) were administered a 2014 Block Food Frequency Questionnaire to assess food intake during the deployment. Self-reported nutrient intake was compared to the MDRIs using one sample t-tests. Self-reported intake of energy, carbohydrate, fiber, vitamin D, and potassium were significantly lower than the MDRIs (P < .001). Intake of fat and protein met the MDRIs (P > .05), although B vitamins, calcium, phosphorus, iron, and sodium all exceeded the MDRIs (P ≤ .001). Relative to body mass, average energy intake was 28.9 kcal/kg, carbohydrate was 3.2 g/kg, protein was 1.3 g/kg, and fat was 1.2 g/kg. Deployed SOF Soldiers may under consume energy and key nutrients, which could jeopardize health, performance, and operational readiness. Tailored nutrition interventions with consideration of operational demands and food/supplement accessibility may be needed to optimize energy and nutrient intake in austere environments.
24. Integrated In Vitro and In Silico Characterization of 5-Hydroxyferulic Acid: Antioxidant, Anti-Inflammatory, Anti-Hemolytic, and Cytotoxic Potential.
期刊: Chemistry & biodiversity 发表日期: 2025-Sep-25 链接: PubMed
摘要
In the pursuit of novel antioxidant and anti-inflammatory agents, we investigated 5-hydroxyferulic acid (5-OHFA), a hydroxylated derivative of the well-known phenolic compound ferulic acid (FA). This study aimed to determine whether structural modification enhances the biological activity of FA. To this end, both compounds were subjected to a series of in vitro antioxidant assays (DPPH, ABTS, FRAP, and Fe(II)-chelating) and anti-inflammatory evaluations, complemented by in silico predictions. 5-OHFA consistently exhibited superior antioxidant capacity, with significantly lower IC50 values than FA based on literature-reported values: 11.89 ± 0.20 versus 66 ± 2.3 µM (DPPH), 9.51 ± 0.15 versus 183.08 ± 2.30 µM (ABTS), 5.94 ± 0.09 versus 4.73 ± 0.14 µM (FRAP), and 36.31 ± 1.36 versus 270.27 ± 1.14 µM (Fe2+ chelation). It also demonstrated stronger anti-inflammatory potential in protein denaturation assays using egg albumin and bovine serum albumin (BSA). Although 5-OHFA showed slightly greater hemolytic activity (IC50 = 23.78 ± 1.48 µM) than FA, based on literature-reported values (37.64 ± 2.01 µM), both remained within biologically acceptable limits. In silico analyses using SwissADME and ProTox III supported the experimental findings, predicting good oral bioavailability, high gastrointestinal absorption, mild blood-brain barrier permeability, and no significant toxicity for 5-OHFA. Molecular docking studies further revealed stronger binding affinities of 5-OHFA to key oxidative and inflammatory targets, including NADPH oxidase (2CDU), xanthine oxidase (1FIQ), 5-lipoxygenase (3O8Y), cyclooxygenase-2 (3LN1), myeloperoxidase (1DNU), and the EGFR enzyme’s active pocket (1M17). Overall, the data suggest that 5-OHFA possesses enhanced bioactivity relative to its parent compound FA, supporting its potential as a promising multifunctional candidate for pharmaceutical or nutraceutical development.
25. Inverse association of cancer with diagnoses of dementia in a large health claims case-control study.
期刊: Journal of Alzheimer’s disease : JAD 发表日期: 2025-Sep-25 链接: PubMed
摘要
BackgroundPrevious studies reported an inverse association of cancer with dementia risk.ObjectiveTo study associations of cancer diagnoses with risk of a dementia diagnosis in a large case-control study.MethodsWe included patients with a dementia diagnosis and controls matched 1:2 for age, sex, region, and earliest year of outpatient treatment in a case-control study from health insurance claims of outpatient consultations. Exposure included seventeen cancer categories. We compared the annual prevalence trajectories of cancer categories between dementia cases and controls over a period of 10 years before the index date. We report unadjusted odds ratios (ORs) and ORs adjusted for established dementia risk factors.ResultsWe included 1,686,759 patients with incident dementia and 3,373,518 matched controls. We identified four types of associations: Cancers with equal or lower prevalence in controls at year -10 and higher prevalence in controls after year 6 to 4 before the index date; with higher prevalence in controls at all time points; with a lower prevalence in controls up to three years before the index date and higher prevalence after that; and with equal prevalence in cases and controls until year -9 and a steep increase in controls after that. When using adjusted ORs the overall pattern of an inverse association of cancer with dementia was maintained.ConclusionsOur data suggest that a mixture of causes contributes to the inverse association of cancer and dementia diagnoses, including selective survival, underdiagnosis of dementia after cancer and of cancer in dementia, but also shared biological factors.
26. Intraoperative diaphragmatic plication during initial surgery with phrenic nerve resection.
期刊: Interdisciplinary cardiovascular and thoracic surgery 发表日期: 2025-Sep-25 链接: PubMed
摘要
Diaphragmatic palsy can result in respiratory failure, potentially alleviated by diaphragmatic plication. Nevertheless, the benefits of preventive plication during phrenic nerve resection remain uncertain. This study evaluated whether preventive plication during primary surgery involving phrenic nerve resection alleviate paradoxical diaphragmatic movement and pulmonary function loss. Among 24,527 surgeries for lung cancer or mediastinal tumors at 11 institutions, 142 involved phrenic nerve resections. Of these, 132 patients were retrospectively analyzed. Diaphragmatic displacement and pulmonary function were assessed pre- and postoperatively. Displacement was quantified by measuring thoracic height on pre- and postoperative chest X-rays (D, D’). Diaphragmatic displacement ratio was defined as: DDR = (D’-D)/D×100. Seventy patients (53%) underwent preventive diaphragmatic plication during the primary surgery; 62 (47%) did not. Differences were significant overall and more pronounced in those undergoing left lobectomy or more extensive resection. In this subgroup, plication was associated with a smaller change in DDR (-30.1 ± 7.7% vs. -20.2 ± 7.7%, p = 0.002), and smaller declines in percent predicted forced vital capacity (-30.5 ± 8.0% vs. -16.8 ± 17.7%, p = 0.029) and forced expiratory volume in one second (-31.6 ± 11.0% vs. -19.0 ± 14.5%, p = 0.046). In patients undergoing left lobectomy or more extensive resections involving phrenic nerve resection, intraoperative diaphragmatic plication may help preserve postoperative pulmonary function. However, due to the small sample size and limited generalizability, these findings should be interpreted cautiously.
27. Advancing the Analysis of Work System Factors and Well-Being in Rural and Urban Healthcare: Perspectives Beyond the COVID-19 Pandemic.
期刊: Workplace health & safety 发表日期: 2025-Sep-25 链接: PubMed
摘要
28. Work-related risk factors of sleep apnea: evidence from the Korean work, sleep, and health study.
期刊: International archives of occupational and environmental health 发表日期: 2025-Sep-25 链接: PubMed
摘要
Occupational exposures are hypothesized to contribute to obstructive sleep apnea (OSA) risk, yet evidence from large, population-based studies remains scarce. This study aimed to investigate the association between a wide range of work-related factors and sleep apnea risk among Korean workers. We analyzed data from the Korean Work, Sleep, and Health Study (KWSHS), a nationwide longitudinal panel survey conducted between 2022 and 2024. Work-related exposures included long working hours, shift work, occupational stress, emotional labor, physical or chemical hazards, and ergonomic factors. Sleep apnea risk was assessed using the Berlin Questionnaire. To account for repeated measurements within individuals, generalized estimating equation models were applied to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for age, sex, and occupation. Subgroup analyses were performed according to obesity status. Among 8,976 workers, long working hours (> 52 h per week; OR 1.22, 95% CI 1.04-1.43), high occupational stress (OR 1.93, 95% CI 1.76-2.12), high emotional labor (OR 1.74, 95% CI 1.50-2.02), physical or chemical exposures (OR 1.37, 95% CI 1.25-1.50), and ergonomic strains (OR 1.36, 95% CI 1.25-1.48) were significantly associated with increased odds of high sleep apnea risk. Shift work was not significantly associated with OSA risk, which may be partially explained by the healthy worker effect or adaptation among long-term shift workers. Associations with physical and chemical exposures were stronger among non-obese participants. Work-related psychosocial and environmental factors contribute meaningfully to sleep apnea risk. Addressing workplace conditions may represent an important strategy for sleep apnea prevention.
29. Occupational risk factors for surgically treated lumbar disc herniation - a 33-year follow-up.
期刊: Scandinavian journal of work, environment & health 发表日期: 2025-Sep-25 链接: PubMed
摘要
This study aimed to assess the associations between occupational biomechanical factors and occurrence of surgically treated lumbar disc herniation (LDH) and describe the consequences in terms of early exit from the labor market. A cohort of 262 850 male construction workers participating in a national occupational health surveillance program was followed prospectively for 33 years (1987-2019). Occupational biomechanical exposures were assessed by a job exposure matrix (JEM) based on specific occupational groups. Workers who underwent surgical treatment for LDH were identified from the national patient register and data on disability pension from the Swedish Social Insurance Agency. Poisson regression models were used to estimate relative risks (RR) and 95% confidence intervals (CI) for biomechanical exposures, adjusted for age, body mass index, smoking status, height and time period. There were 2451 cases of surgical treatment for LDH and the incidence peaked at age 40-45 years. Increased risks were found for often lifting >25 kg (RR 1.77, 95% CI 1.06-2.94), extreme lumbar flexion/extension (RR 1.60, 95% CI 1.37-1.88) and high exposure to whole-body vibration (RR 1.32, 95% CI 1.05-1.65). Among cases, the mean age for exiting the labor market due to disability pension was 55.9 years for white-collar workers and 51.7 years for construction workers. Occupational exposure to heavy lifting and working in non-neutral back postures was associated with increased risk of surgical treatment for LDH. Construction workers who have had surgery for LDH exited the labor market with disability pension earlier than white-collar workers.
30. Level of education, labor-market marginalization, and alcohol-related mortality: a cohort study of Swedish men.
期刊: European journal of public health 发表日期: 2025-Sep-25 链接: PubMed
摘要
Social inequalities in alcohol-related morbidity and mortality are well-established, but the reasons are not fully understood. One possible reason is labor market difficulties stemming from lower educational qualifications, leading to alcohol-related harm. The present study aims to investigate the extent to which differences in labour market marginalization (LMM) (including differences in timing and type of LMM) explain educational differences in alcohol-related mortality, and whether this is independent of pre-labor market selection factors. A register-based cohort study included all men born between 1949 and 1951 who underwent Swedish military conscription in 1969/70 and were alive at age 55 (n = 45 168). Nationwide registers provided data on education level and alcohol-related mortality. LMM was measured by unemployment, sickness absence, and disability pension. Pre-labor market factors included health behaviors, cognitive ability, and health from conscription exams. Cox regression analyses were used to obtain hazard ratios (HR) with 95% confidence intervals (CI). The explanatory role of LMM was assessed by percentage attenuation of HR. Men with primary and secondary education had higher risks of alcohol-related mortality (HR: 4.23, HR: 2.92) compared to those with university education. LMM explained a substantial part of these differences (42% and 37%). However, LMM’s effect was smaller (18% and 7%) when pre-labor market factors were considered. Men with lower education levels in Sweden are more likely to die from alcohol-related causes compared to higher educated men. While differences in LMM contribute to these disparities, its explanatory power diminishes when considering pre-labor market factors, suggesting potential selection effects.
31. A mosaic H3 subtype live attenuated influenza vaccine elicits broad immune responses to influenza a viruses.
期刊: Vaccine 发表日期: 2025-Sep-24 链接: PubMed
摘要
Influenza A(H3N2) viruses are typically associated with reduced vaccine effectiveness (VE), especially in the elderly. To address this challenge, we developed a novel live attenuated influenza vaccine (LAIV) expressing a mosaic H3 hemagglutinin designed to maximize potential cytotoxic T lymphocyte (CTL) epitope coverage, using the A/Leningrad/134/17/57 (H2N2) backbone. The resulting mosaic reassortant virus exhibited temperature-sensitive and cold-adapted phenotypes and caused no significant weight loss or clinical signs in mice. Following prime-boost intranasal immunization in BALB/c mice, robust cellular immune responses were observed, with increased frequencies of splenic and pulmonary IFN-γ+ and IL-4+ T cells after restimulation, as well as elevated levels of pulmonary tissue-resident memory T cells. High levels of cross-reactive IgA were also detected in nasal and bronchoalveolar lavage fluids, covering multiple influenza virus strains. Additionally, broad serum antibody responses were induced, with HI and MN antibodies targeting 8 and 7 of 9 H3N2 vaccine strains. Virus challenge results showed that the mosaic reassortant virus conferred complete protection against the homologous-subtype strain A/Aichi/2/1968 (H3N2) and partial protection against the heterosubtypic strains A/Puerto Rico/8/1934 (H1N1) and A/Hunan/42443/2015 (H1N1), with survival rates of 20 % and 40 %, respectively. In contrast, all mice vaccinated with traditional monovalent LAIV or inactivated influenza vaccine showed 0 % survival. Moreover, lung viral loads showed a decreasing trend after infection, and pathological damage in the lungs was markedly alleviated compared to other groups. These findings suggest that combining the mosaic antigen with LAIV induces multi-layered immune responses and provides a rational vaccine design strategy for addressing the rapid antigenic evolution of H3N2 viruses.
32. Knowledge and attitudes of Nigerian neurologists towards physical exercises for people with epilepsy; a cross-sectional study.
期刊: Epilepsy & behavior : E&B 发表日期: 2025-Sep-24 链接: PubMed
摘要
Physical exercises have been found highly beneficial in the care and well-being of people with epilepsy (PWE); however, the lower participation in these activities by PWEs is still observed. Given that neurologists play a big role in guiding treatment and lifestyle recommendations, we assessed the knowledge, and attitudes of neurologists in Nigeria regarding physical exercise for PWEs. This cross-sectional study consecutively recruited neurologists from selected tertiary hospitals in Nigeria. Data were collected using the 22-item Neurologists Knowledge of and Attitudes towards Physical Exercise for People with Epilepsy Questionnaire. Descriptive and inferential were analysed using the Statistical Package for Social Sciences. A total of 82 neurologists (62.2 % male), aged 38.95 ± 7.82 years, participated in the study. Most had less than five years of professional experience (59.8 %), worked in urban areas (58 %), public facilities (45 %), and cared for about five PWE monthly. While 75.6 % knew which sports to recommend, only 13.4 % felt adequately equipped to provide comprehensive exercise guidance. Over half (52.4 %) reported that their patients exercised 3 to more than 5 times weekly, yet 30.5 % never asked about their patients’ physical activity habits. Commonly reported barriers to exercise included family overprotection (85.4 %), fear of seizures (82.9 %), low self-esteem (84.1 %), and stigma (80.5 %). The studied neurologists largely acknowledge the benefits of physical exercise for PWE and frequently encourage participation, their practices are still shaped by lingering fears, limited training, and uncertainties around safety.
33. The psychological impacts of climate change on pregnant women in Türkiye.
期刊: Women and birth : journal of the Australian College of Midwives 发表日期: 2025-Sep-24 链接: PubMed
摘要
Climate change poses serious risks to both physical and mental health. Pregnant women are especially vulnerable, as the stress and anxiety associated with this period may be intensified by climate-related challenges, potentially affecting maternal well-being and pregnancy outcomes. This study was conducted to determine the repercussions of climate change on the mental health of pregnant women. This study utilized a descriptive qualitative design. The data were collected by holding individual semi-structured interviews with pregnant women (n = 17). Thematic analysis was used to analyse the data. The main themes of this study were ‘anxiety and insecurity about the future,’ ‘psychological burdens caused by climate change,’ ‘coping with psychological burdens associated with the impact of climate change,’ and ‘expectations from healthcare professionals’. The main themes consist of six sub-themes: ‘concerns about the future of children,’ ‘uncertainty about the future,’ ‘climate anxiety and stress,’ ‘sense of ecological loss and sadness,’ ‘avoidance,’ and ‘spiritual practices’. Climate change adversely affects the quality of life of pregnant women and imposes a significant burden on their mental health. Healthcare professionals should integrate climate-related awareness and coping strategies into their practice and promote broader public awareness. Such efforts can contribute to policies that safeguard the rights of pregnant women and their families to live in a healthy and sustainable environment.
34. Environmental Factors of Food Insecurity in Adolescents: A Global Scoping Review.
期刊: The Journal of adolescent health : official publication of the Society for Adolescent Medicine 发表日期: 2025-Sep-24 链接: PubMed
摘要
Adolescent food insecurity (FI) is a growing global issue with significant health and developmental consequences. Although research has mainly focused on behavioral and interpersonal factors, broader environmental influences-such as organizational, community, societal, and planetary factors-are underexplored. This scoping review aims to map and examine multilevel environmental factors of adolescent FI (ages 10-19 years). Following PRISMA-Scoping Reviews guidelines, we screened 5,149 records and included 40 studies, mostly from high-income countries. This scoping review identifies key factors such as interpersonal (household socioeconomic status, family structure), community (social capital, food environment), and societal factors (food assistance programs, economic disparities, and discrimination). However, planetary-level factors were rarely studied. Findings suggest that adolescent FI is shaped by interwoven environmental factors across multiple levels, and policies must address systemic drivers such as social inequities and climate change. Future research should prioritize adolescent-centered studies and expand investigations in underrepresented regions, particularly in the Global South.
35. Association between exposure to perfluoroalkyl compounds during early pregnancy and risk of late miscarriage: The Japan Environment and Children's Study.
期刊: International journal of hygiene and environmental health 发表日期: 2025-Sep-24 链接: PubMed
摘要
Previous studies have suggested that perfluoroalkyl and polyfluoroalkyl substances (PFAS) could be related to the occurrence of miscarriages, but the results are inconclusive. Therefore, this study aimed to assess the effects of PFAS exposure during the first trimester on miscarriages that occurred between 12 and 22 weeks of gestation. The participants were mothers and infants that registered for the Japan Environment and Children’s Study. Twenty-eight PFAS, including perfluorooctanoic acid, perfluorohexane sulfonate, and perfluorooctane sulfonate, were identified in the plasma collected from pregnant participants. Miscarriage information was transcribed from the medical records. A propensity score was used to select the control group (mothers that gave live births), that matched the miscarriage group. The detection and concentrations of the PFAS in the miscarriage and control groups were compared. Among 24,412 pairs of maternal PFAS measurements, 66 miscarriages (0.3 %) were documented. No significant differences in the detections or concentrations of PFAS were found between the miscarriage and live birth groups (p > 0.196). No association between prenatal PFAS exposure and late miscarriage was observed. Further studies are required owing to the small sample size.
36. Helminth control practices used by equine keepers in France: a national survey.
期刊: Preventive veterinary medicine 发表日期: 2025-Sep-22 链接: PubMed
摘要
In light of the increasing reports of anthelmintic (AH) resistance in equids, a national survey on helminth control practices was distributed to 42 528 keepers. A total of 4 344 responses was obtained. Respondents implemented preventive pasture practices with varying frequency according to the age of the animals, such as pasture rotations (78.1-80.6 %), excrement removal from pastures several times a year (15.9-27.2 %) and/or mixed or rotational grazing with ruminants (14.5-18.1 %). A majority of keepers routinely used AH treatments even though they did not perceive any major risk to the health of the equids from parasites (65.3-90.4 % according to animal age). The most commonly used AH molecule was ivermectin (73.7 % of users in foals and 92.1 % in older animals). Around 70 % of respondents estimated weight by visual inspection or systematically assigned a predefined quantity of AH that was identical for all animals. Deworming frequency varied according to respondent status (professionals > non-professionals), animal age (foals > older animals) and breed groups kept (galloping horses > other breed groups). Only 5.2 % of respondents collected faeces from animals > 1 year old for coproscopic analysis and selective treatment. Among those surveyed, 20.6 % used a wide variety of products, raw or processed, mainly purchased online, as alternative or complementary methods to veterinary treatments. Veterinarians were the main source of information and advice for implementing deworming protocols. These results demonstrate that there is room for improvement in practices for controlling helminths. They could serve as a basis for developing a guide to best practices, to be distributed to veterinarians and equine keepers during training sessions.
37. Evaluation of the National HIV Surveillance System: 2018-2023.
期刊: Journal of public health management and practice : JPHMP 发表日期: 2025-Sep-22 链接: PubMed
摘要
To evaluate the United States’ National HIV Surveillance System (NHSS), 2018-2023. Surveillance performance outcome standards were calculated by health departments using a SAS program provided by the Centers for Disease Control and Prevention (CDC) and were reported to CDC through an annual report. Submitted data from 59 health departments including the 50 US states, the District of Columbia, 6 separately funded cities (Chicago, Houston, Los Angeles County, New York City, Philadelphia, and San Francisco), and 2 territories (Puerto Rico and the US Virgin Islands). Cases of HIV reported to the health departments based on data reported through the end of each year, 2018-2023. Outcome standards included measures for case ascertainment, duplicate review, risk factor information, data quality, laboratory reporting, antiretroviral use history information, cause of death, previous negative test result, geocoding, and data dissemination. Achievement varied by standard with almost all health departments (HDs) meeting certain standards every year and fewer than 10 HDs achieving other standards. During the period of assessment, results showed steady and improved performance in several measures. Standards related to recent enhancements in the surveillance system were not as resilient and showed potential for improvement. Continued monitoring is necessary to ensure further strengthening of NHSS.
38. Hypertension Prevalence and Determinants in Urban Coastal Communities in Ghana.
期刊: Journal of public health management and practice : JPHMP 发表日期: 2025-Sep-22 链接: PubMed
摘要
The frequency of hypertension in Ghana has risen dramatically in recent decades. Inadequate diagnosis and inappropriate care of diagnosed cases has led to increased mortality and morbidity from poor blood pressure control and associated consequences, especially in areas with low socioeconomic status. This study aimed to assess the prevalence of hypertension and its determinants in underserved coastal communities in Ghana. This screening survey is part of a quasi-experimental initiative in 8 coastal towns to detect hypertension patients and connect them to local care. The initial survey examined 10 000 consenting individuals aged 18 years and older in these localities. Poisson regression model was used to determine the associations of socioeconomic factors with hypertension occurrence. The median age of the study participants was 38 years, majority being women (65.3%). The overall age-standardized hypertension rate was 26.0% (95% CI: 25.1-26.9), with significant variability across subdistricts and communities ranging from 22.0% (95% CI: 20.1-23.8) in Ga South to 32.7% (95% CI: 30.2-35.2) in Krowor. The prevalence of hypertension decreased with increasing levels of monthly income with those earning GHC 1501-2000 having the lowest adjusted prevalence ratio (aPR, 0.64; 95% CI: 0.49-0.84). Besides age, female sex (aPR, 1.18; 95% CI: 1.08-1.28), being married (aPR, 1.19; 95% CI: 1.05-1.35), and alcohol consumption (aPR, 1.23; 95% CI: 1.13-1.35), were significantly associated with increased prevalence of hypertension. The coastal communities in Ghana are highly affected by hypertension with a remarkably high prevalence in women. Tailored public health strategies such as education on lifestyle modification, creation of recreational areas, use of telemedicine and mobile applications for monitoring, and follow-up may help to decrease the risk of hypertension and its complications in these communities.
39. Patterns of treatment prior to death among those with lung cancer: A national study in a universal healthcare context.
期刊: Lung cancer (Amsterdam, Netherlands) 发表日期: 2025-Sep-20 链接: PubMed
摘要
The intensity of cancer treatment delivered to patients in their final days of life will likely vary depending on many factors. This study examines interventional procedures, radiation therapy and systemic therapy receipt in the 30 days prior to death in a national cohort of lung cancer patients who were diagnosed and died between 2012-2019 (n = 14,822), and explores the extent to which this receipt differs depending on multiple sociodemographic and cancer-related factors. We found that the most common form of treatment was palliative radiation therapy (age std. proportion: 11 %), followed by palliative interventional procedures (6 %) and systemic therapy (5 %). Curative interventional procedures and curative radiation therapy were extremely rare prior to death (<1%). Almost all palliative interventional procedures were drainage or pleurodesis procedures (99 %). Receipt of palliative radiation therapy and systemic therapy (but not interventional procedures) reduced with increasing age, and also with increasing comorbidity. Palliative interventional procedures and palliative radiation therapy were more likely among those with non-small cell lung cancers than other forms, while those with small-cell lung cancers were much more likely to receive systemic therapy toward the end of life. Our findings tentatively indicate that clinical services in New Zealand are appropriately reducing futile treatment toward the end of life, although more work is needed to explore this with more granularity than possible in the current study.
40. Button-related finger injuries in textile workers: the hidden danger of the industry.
期刊: Acta orthopaedica et traumatologica turcica 发表日期: 2025-Sep-12 链接: PubMed
摘要
Objective: This study aimed to evaluate button-related injuries, which are increasingly common in the textile and apparel manufacturing sector, to contribute to diagnosis and treatment and to raise awareness among employers and workers. Methods: This retrospective study included 23 patients with button-related injuries. The study evaluated patient demographics, the department they presented to, the level of hand injury, accompanying pathologies (osseous, neurological, vascular, and tendinous injuries), tetanus immunization status, occupational health and safety training status, awareness of workplace physicians, prior awareness of such injuries, history of occupational accidents, and long-term outcomes. Statistical analyses were performed using SPSS v21. Descriptive data were summarized as frequency (%) or mean ± SD, and the Shapiro-Wilk test was used to assess normality. Results: Among the 23 patients (14 males, 9 females), 16 sustained injuries to the distal phalanx and pulp level, while 7 had injuries at the middle phalanx level. At presentation, 4 patients exhibited hypoesthesia on the a!ected side of the finger, and 9 patients had reduced blood flow. Two patients had accompanying phalanx fractures. No tendinous pathologies were observed in any of the patients. All patients underwent surgical intervention. Seven patients developed nail deformities in the follow-up. Conclusion: Timely intervention and appropriate treatment after an injury are crucial for limb salvage and functionality. In long-term follow-ups, most patients healed without major complications; however, some the patients developed nail deformities. Level of Evidence: Level IV, Therapeutic Study.
41. Cyclone exposure and mortality risk of children under 5 years old: An observational study in 34 low- and middle-income countries.
期刊: PLoS medicine 发表日期: 2025-Sep 链接: PubMed
摘要
Climate change has exacerbated the frequency, intensity, and impacts of extreme weather events (EWEs), such as tropical cyclones. However, the increasing impact of tropical cyclones on child mortality, especially in low- and middle-income countries (LMICs), remains understudied. Utilizing individual-level data from the Demographic and Health Surveys, we conducted a sibling-matched case-control study to assess the impact of cyclone exposure over the past 3 months on under-five mortality. The study included 100,798 under-five deaths and 247,445 controls across 34 LMICs from 1993 to 2021. After adjusting for key meteorological and temporal confounders and maternal age, significant positive associations were observed between under-five deaths and cyclone exposure over the past 3 months before death (odds ratio [OR]: 1.038, 95% confidence interval [CI]: 1.002, 1.075; p = 0.041). Specifically, the strongest effects were observed in the first month before death (OR: 1.101, 95% CI: 1.039, 1.166; p < 0.001), diminishing in the second and third months before death. We estimated that cyclone exposure 0-30 days before death may have caused 0.85 million under-five deaths (95% CI: 0.35 million, 1.32 million) in countries exposed to cyclones from 2000 to 2020. As an observational study, its use of self-reported data and dichotomous exposure assessment may introduce recall bias and exposure misclassification, limiting accuracy and representativeness. This global analysis demonstrates the substantial under-five mortality risk from cyclones, emphasizing the importance of targeted strategies to enhance community resilience against the growing threat of EWEs on children, such as improving access to water sources and sanitation facilities.
42. Clinical Profile and Outcomes of ST-Elevation Myocardial Infarction in Patients Under 45 Years.
期刊: Critical pathways in cardiology 发表日期: 2025-Aug-26 链接: PubMed
摘要
ST-segment elevation myocardial infarction (STEMI) remains a leading cause of global mortality. Although overall incidence is declining, this trend is less evident among younger individuals, emphasizing the need to better understand modifiable risk factors and clinical outcomes in this population. To analyze the clinical profile and outcomes of young patients with STEMI undergoing primary percutaneous coronary intervention (pPCI) in a contemporary cohort. This prospective cohort study included patients aged ≥18 years with confirmed STEMI treated with pPCI at a tertiary university hospital from March 2011 to January 2025. Patients were stratified into two groups: young (≤45 years) and older (>45 years). The primary outcome was in-hospital mortality. A two-sided significance level of p<0.05 was adopted. A total of 2,050 patients were included; 191 (9.3%) were ≤45 years old (mean age: 39.9 years). Younger patients showed significantly lower in-hospital mortality (4.2% vs. 12.1%; p=0.001), shorter median length of stay (5 vs. 6 days; p=0.001), and lower incidence of long-term major adverse cardiovascular and cerebrovascular events (15.2% vs. 24.7%; p=0.003). They had higher prevalence of active smoking (57.1% vs. 40.6%; p<0.001), illicit drug use (18.3% vs. 10.0%; p<0.001), HIV infection (4.7% vs. 2.2%; p=0.003), and family history of coronary artery disease (24.2% vs. 12.4%; p<0.001). Young STEMI patients presented with fewer comorbidities and lower in-hospital mortality, but a higher prevalence of behavioral risk factors. These findings highlight the need for targeted preventive strategies and early detection to improve long-term outcomes.
43. Síndrome de médula anclada en pediatría. Presentación clínica, diagnóstico, etiología y resultados del tratamiento médico-quirúrgico.
期刊: Boletin medico del Hospital Infantil de Mexico 发表日期: 2025 链接: PubMed
摘要
Tethered cord syndrome (TCS) is the clinical manifestation of abnormal traction of the spinal cord, causing sensory-motor impairment of the lower limbs, scoliosis, low back pain, bladder and intestinal dysfunction; cutaneous abnormalities may be present. The diagnosis is suspected through clinical history and detailed physical examination. It is complemented by ultrasound and lumbosacral magnetic resonance imaging. A retrospective study was carried out from April 2019 to October 2024. The inclusion criteria: a) Under 17 years old; b)symptoms and physical examination compatible with TCS; c) imaging diagnosis of TCS, and d) having undergone surgery. The results are reported at 12 months after surgery. Eighteen patients were evaluated, with an average age of 83.27 months (2-180). The etiology was hypertrophic filum (n = 6), dermal sinus (n = 4), lipomyelomeningocele (n = 4), lipomatosus filum (n = 2), and postoperative myelomeningocele (n = 2). The preoperative symptoms were bladder dysfunction 33.33%, constipation 33.33%, paraplegia 22.22%, paresthesia 22.22%, low back pain 22.22%, claw toes 16.66%, fever 16.66%, cerebrospinal fluid leakage 5.55%, club foot 5.55%, scoliosis 5.55%, and acute abdominal pain 5.55%. There were cutaneous stigmata in 61.11%. Magnetic resonance imaging was used in 17 patients and ultrasound in two. With surgery there was improvement in preoperative symptoms, the Wilcoxon test gave us a p < 0.001. Surgery helps to reduce symptoms and prevent further neurological damage; in asymptomatic patients it prevents the risk of neurological injury. El síndrome de médula anclada (SMA) es la manifestación clínica de una tracción anormal de la médula espinal, ocasionando afección sensitivo-motora de extremidades inferiores, escoliosis, lumbalgia y disfunción vesical e intestinal; pueden coexistir anomalías cutáneas. El diagnóstico se sospecha mediante la historia clínica y exploración física detallada, complementándose con el ultrasonido y la resonancia magnética lumbosacra. Se realizó un estudio retrospectivo de abril de 2019 a octubre de 2024. Criterios de inclusión: a) menor de 17 años; b) sintomatología y exploración física compatible con SMA; c) diagnóstico por imagen de SMA, y d) haber sido intervenidos quirúrgicamente. Se reportan los resultados a los 12 meses del posquirúrgico. Se evaluaron 18 pacientes, con una edad promedio de 83.27 meses (2-180). La causa fue filum hipertrófico (n = 6), seno dérmico (n = 4), lipomielomeningocele (n = 4), filum lipomatoso (n = 2) y operado de mielomeningocele (n = 2). Los síntomas preoperatorios fueron disfunción vesical 33.33%, estreñimiento 33.33%, paraplejia 22.22%, parestesias 22.22%, lumbalgia 22.22%, dedos de pies en garra 16.66%, fiebre 16.66%, salida de líquido cefalorraquídeo 5.55%, pie equino 5.55%, escoliosis 5.55% y dolor abdominal agudo 5.55%. Hubo estigmas cutáneos en el 61.11%. Se utilizó resonancia magnética en 17 pacientes y ultrasonido en dos. Con la cirugía hubo mejoría de la sintomatología prequirúrgica, la prueba de Wilcoxon nos dio un valor de p < 0.001. La cirugía ayuda a disminuir la sintomatología y evitar una mayor afección neurológica; en pacientes asintomáticos previene el riesgo de daño neurológico.
44. Diagnóstico y tratamiento de bronquiectasias en pacientes pediátricos sin fibrosis quística.
期刊: Boletin medico del Hospital Infantil de Mexico 发表日期: 2025 链接: PubMed
摘要
Bronchiectasis is characterized by the permanent dilation of bronchi, clinically presenting with chronic cough, sputum production, dyspnea, and recurrent exacerbations. Bronchiectasis can occur due to genetic disorders, congenital malformations, endobronchial obstruction of infectious and inflammatory origin, and chronic aspiration, among other causes. Bronchial dilation leads to impaired mucociliary clearance, trapping particles and microorganisms in the airways. Macrophages and epithelial cells release proinflammatory cytokines that promote neutrophil chemotaxis. Neutrophils release enzymes causing epithelial cell damage, reducing ciliary motility, promoting glandular hyperplasia, and increasing mucus secretion. Persistent infection perpetuates local inflammation in bronchiectasis patients. Diagnosis requires high clinical suspicion and early detection improves clinical outcomes. High-resolution computed tomography is the gold standard for confirmation. A comprehensive medical history, initial assessments with complete blood count, total serum immunoglobulins, iontophoresis, and spirometry help assess the underlying etiology and disease severity. The primary goal is preserving lung function and halting disease progression. This involves adopting healthy lifestyles, expanded vaccination schedules, respiratory therapy, and early antibiotic use for exacerbations and colonization by specific microorganisms. Las bronquiectasias son anomalías caracterizadas por dilatación permanente de los bronquios; clínicamente se manifiestan con tos crónica, producción de esputo, disnea y exacerbaciones recurrentes. Las bronquiectasias ocurren como resultado de enfermedades genéticas, malformaciones congénitas, obstrucción endobronquial de causa infecciosa e inflamatoria y aspiración crónica, entre otras causas. La dilatación bronquial conlleva alteración de la depuración mucociliar, facilitando el atrapamiento de partículas y microorganismos que ingresan a las vías respiratorias. Los macrófagos y células epiteliales liberan citocinas proinflamatorias que promueven la quimiotaxis de neutrófilos, los cuales liberan enzimas que causan lesión en las células epiteliales, reducen la motilidad ciliar, promueven la hiperplasia glandular y el aumento en la secreción de moco, de esta forma la infección persistente perpetúa la inflamación local en los pacientes con bronquiectasias. El diagnóstico requiere un alto índice de sospecha clínica y la detección precoz permite mejorar los desenlaces clínicos. La tomografía axial computarizada de alta resolución pulmonar es el método de referencia para la confirmación diagnóstica; la realización de historia clínica completa y estudios de extensión iniciales como hemograma, inmunoglobulinas séricas totales, iontoforesis y espirometría permiten evaluar la causa subyacente y determinar la gravedad de la enfermedad. El principal objetivo del manejo es preservar la función pulmonar y detener la progresión de la enfermedad, para lo que se recomienda adoptar hábitos de vida saludables, esquemas de vacunación ampliados, realización de terapia respiratoria y uso temprano de antibióticos en exacerbaciones y colonizaciones por ciertos microorganismos.
45. Complications and blood transfusions in newborns are associated with a higher milliliters per kilogram ratio of blood extracted for laboratory studies.
期刊: Boletin medico del Hospital Infantil de Mexico 发表日期: 2025 链接: PubMed
摘要
Phlebotomy-associated blood loss is a clinical concern in term and pre-term newborns. Previous reports have associated a higher volume of phlebotomy associated blood loss to a more pre-term status and to the need for blood transfusions. The present study was undertaken to evaluate the amount of phlebotomy-associated blood loss and its associations. Retrospective, observational, and analytical study conducted through a retrospective chart review. The primary objective was to determine the association between the presence of the endpoint “any complications” and the mean phlebotomy-associated blood loss in milliliters/kilograms (mL/kg). Blood loss was quantified using the corresponding documentation sheet in the clinical record, as reported by the nursery service. 176 patients were included in the present study. Male: female ratio was 1.67:1.00. Mean gestational weeks was 34.2 with a standard deviation of 3.7. Patients meeting the composite endpoint “any complications” had a higher mean mL/kg of phlebotomy-associated blood loss than those who did meet it (10.93 vs. 2.91, p < 0.001). In addition, patients requiring blood transfusions had higher mL/kg of phlebotomy-associated blood loss than those who did not (21.16 vs. 4.21, p < 0.001). Finally, more pre-term status was significantly associated with a higher phlebotomy-associated blood loss (p < 0.001). The presence of any complications, more pre-term status and need for blood transfusions was significantly associated with a higher mL/kg phlebotomy-associated blood loss. Bigger, prospective studies controlling other variables and temporality are needed to fully grasp the clinical consequences of a high mL/kg phlebotomy-associated blood loss. La pérdida de sangre asociada a la flebotomía es una preocupación clínica en los recién nacidos a término y prematuros. Informes previos han asociado un mayor volumen de pérdida de sangre asociada a la flebotomía con un estado más prematuro y con la necesidad de transfusiones de sangre. El presente estudio se realizó para evaluar la cantidad de pérdida de sangre asociada a la flebotomía y sus asociaciones. Estudio retrospectivo, observacional y analítico realizado por medio de una revisión retrospectiva de historias clínicas. El objetivo principal fue determinar la asociación entre la presencia del objetivo compuesto «cualquier complicación» y la pérdida de sangre media asociada a la flebotomía en mL/kg. La pérdida de sangre se cuantificó usando la hoja correspondiente en el expediente clínico documentada por el servicio de enfermería. Se incluyeron 176 pacientes en el presente estudio. La relación hombre: mujer fue de 1.67:1.00. La media de semanas de gestación fue de 34.2, con una desviación estándar de 3.7. Los pacientes que cumplieron con el criterio de valoración compuesto «cualquier complicación» tuvieron una media mayor de mL/kg de pérdida de sangre asociada a la flebotomía que aquellos que sí lo cumplieron (10.93 vs. 2.91; p < 0.001). Además, los pacientes que requirieron transfusiones de sangre tuvieron una mayor pérdida de sangre asociada a la flebotomía en mL/kg que aquellos que no las requirieron (21.16 vs. 4.21; p < 0.001). Finalmente, un mayor estado de prematuridad se asoció significativamente con una mayor pérdida de sangre asociada a la flebotomía (p < 0.001). La presencia de cualquier complicación, un mayor estado de prematuridad y la necesidad de transfusiones de sangre se asociaron significativamente con una mayor pérdida de sangre asociada a la flebotomía en mL/kg. Se necesitan estudios prospectivos más amplios que controlen otras variables y la temporalidad para comprender plenamente las consecuencias clínicas de una alta pérdida de sangre asociada a la flebotomía en mL/kg.
46. Relación entre genotipo y carga viral de virus del papiloma humano y la gravedad de presentación de la papilomatosis respiratoria recurrente en niños.
期刊: Boletin medico del Hospital Infantil de Mexico 发表日期: 2025 链接: PubMed
摘要
Recurrent respiratory papillomatosis is a condition that occurs mainly in the pediatric population with a rate of 3.62 to 4.3 per 100,000 children. The most common clinical manifestation is dysphonia; however, the disease can progress to more severe forms, generating serious obstruction of the airway. A cross-sectional study was conducted in which patients diagnosed with laryngeal papillomatosis confirmed by histopathological analysis and polymerase chain reaction were included. The genotype of the virus and its viral load were determined through a search in the clinical records, and the clinical and genetic variables of each case were captured through a structured form. A total of 32 patients were enrolled, of which the prevalence of genotype 6 was found in 41% and the same prevalence in the case of genotype 11, with a percentage of coinfection with both subtypes of 18%. Genotype 11 was found to be associated with a greater number of resections (p = 0.004), a higher score on the Derkay scale (p = 0.02) and greater severity when presenting ≥ 4 surgeries per year and/or ≥ 10 total surgeries (p = 0.04). Human papillomavirus genotype 11 showed a greater association with the presentation of greater severity of recurrent respiratory papillomatosis in pediatric patients; therefore, this population is more susceptible to a poor outcome (which increases the demand for medical services), as well as impact on the quality of life of minors. La papilomatosis respiratoria recurrente es un padecimiento que se presenta mayormente en la población pediátrica con una tasa de 3.62 a 4.3 por cada 100,000 menores. La manifestación clínica más frecuente es la disfonía; sin embargo, la enfermedad puede progresar a formas más graves, generando obstrucción grave de las vías respiratorias. Se realizó un estudio transversal en el cual se incluyeron pacientes diagnosticados con papilomatosis laríngea confirmado por medio de análisis histopatológico y reacción en cadena de la polimerasa; se determinó el genotipo del virus y su carga viral mediante su búsqueda en los expedientes clínicos, por medio de un formulario estructurado se capturaron las variables clínicas y genéticas de cada caso. Se incorporaron 32 pacientes, con prevalencia del genotipo 6 del 41% y la misma prevalencia en el genotipo 11, con un porcentaje de coinfección con ambos subtipos del 18%. El genotipo 11 se encontró asociado a un mayor número de resecciones (p = 0.004), un puntaje mayor en la escala de Derkay (p = 0.02) y una gravedad mayor al presentar ≥ 4 cirugías por año o ≥ 10 cirugías totales (p = 0.04). El genotipo 11 del virus del papiloma humano se asoció a mayor gravedad de papilomatosis respiratoria recurrente en los pacientes pediátricos, por lo tanto, dicha población resulta más susceptible a una peor evolución (lo que incrementa la demanda de atención a los servicios médicos), así como a afectación en la calidad de vida de los menores.
47. Salud mental parental en cardiopatías congénitas: eficacia de un programa psicoeducativo perioperatorio en línea.
期刊: Boletin medico del Hospital Infantil de Mexico 发表日期: 2025 链接: PubMed
摘要
Invasive medical procedures in children with congenital heart disease (CHD) increase parental anxiety and stress with a negative impact on the disease and children’s coping. Parental psychoeducational programs promote their mental health and positive impact on pediatric health. The objective was to evaluate the efficacy of an online psychoeducational program to promote the mental health of parents of children with CHD who are about to undergo an invasive medical procedure. Forty-three mothers and fathers of children with CHD about to undergo catheterization or cardiac surgery belonging to the Live Longer Mexico Foundation participated, divided alternately into two groups: 1) online psychoeducational program (n = 22), and 2) control (n = 21). Mental health was evaluated based on three indicators: parental stress, state/trait anxiety and worry before the procedure. The PSI-SF Parental Stress Index, the Parental Worry about Surgery Questionnaire and the Trait-State Anxiety Inventory were used. The group with the psychoeducational program showed a statistically significant decrease in state anxiety and worry about the medical procedure. Additionally, state anxiety and worry about the medical procedure are significantly lower in the group that received the psychoeducational program compared to the control. Parental stress had no significant intra- and inter-group changes. The online psychoeducational program is effective in favoring parental mental health, specifically on state/trait anxiety and worry about surgery in parents of children with CC nearing catheterization or cardiac surgery. Los procedimientos médicos invasivos en niños con cardiopatía congénita (CC) incrementan la ansiedad y el estrés parentales, repercutiendo negativamente en la enfermedad y el afrontamiento infantil. Los programas psicoeducativos promueven la salud mental parental y el impacto positivo en la salud pediátrica. El objetivo fue evaluar la eficacia de un programa psicoeducativo en línea para favorecer la salud mental de padres de niños/as con CC próximos a un procedimiento médico invasivo. Participaron 43 mamás y papás de niños con CC próximos a cateterismo o cirugía cardiaca pertenecientes a la Fundación Live Longer México, divididos de forma alternada en dos grupos: 1) programa psicoeducativo en línea (n = 22), y 2) control (n = 21). La salud mental se evaluó a partir de tres indicadores: estrés parental, ansiedad-estado/rasgo y preocupación ante el procedimiento. Se utilizaron el Índice de estrés parental (PSI-SF), el Cuestionario sobre la preocupación paterna sobre la cirugía y el Inventario de Ansiedad-rasgo-Estado. El grupo con programa psicoeducativo mostró una disminución estadísticamente significativa en la ansiedad-estado y la preocupación por el procedimiento médico. Adicionalmente, la ansiedad-estado y la preocupación por el procedimiento médico son menores significativamente en el grupo que recibió el programa psicoeducativo en comparación con el control. El estrés parental no tuvo cambios significativos intra- e intergrupo. El programa psicoeducativo en línea es eficaz para favorecer la salud mental parental, específicamente en la ansiedad-estado/rasgo y la preocupación por la cirugía en los padres de niños con CC próximos a un cateterismo o cirugía cardiaca.
48. Dengue congénito como diagnóstico diferencial en neonatos con sospecha de sepsis neonatal: reporte de caso en una región endémica.
期刊: Boletin medico del Hospital Infantil de Mexico 发表日期: 2025 链接: PubMed
摘要
A major dengue epidemic affected Peru in 2023, with more than 246,614 cases with 419 deaths and an approximate of 8,312 pregnant women affected, with risk of transmitting the virus to the fetus. The case of an 11-day-old newborn is reported, whose mother started dengue fever one day before delivery, who was admitted to the emergency room with a diagnosis of sepsis (fever, jaundice, alteration of sensorium) and a history of cesarean delivery due to acute fetal distress. RT-PCR for dengue serotype 2 was identified in both the mother and neonate, suspending antibiotics and starting controlled hydration therapy, with favorable evolution that allowed the 7 to be discharged from hospitalization. Congenital dengue should be suspected in any neonate whose mother presents dengue up to 10 days before delivery and who presents a clinical picture of sepsis, and we must monitor the neonate until the 12th day of life. La epidemia de dengue ha afectado de forma muy importante al Perú en el 2023, con más de 273,000 casos y más de 444 fallecidos. Las gestantes de zonas endémicas también han sido afectadas y se reportan más de 8,312 gestantes infectadas. Se reporta el caso de un neonato de 11 días de vida con síntomas de fiebre, ictericia, alteración del sensorio y antecedente de parto cesárea por sufrimiento fetal agudo. Se identifica RT-PCR para dengue serotipo 2 en madre y neonato, suspendiéndose antibióticos e iniciando terapia de hidratación controlada con evolución favorable. Se debe sospechar un caso de dengue congénito ante todo neonato cuya madre presenta dengue hasta 10 días antes del parto y que presente cuadro clínico de sepsis con vigilancia al neonato hasta el 12 día de vida.
49. Structural assessment of family and educational influences on student health behaviours: Insights from a public health perspective.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
The 2024 World Health Organization report reveals that 81% of adolescents worldwide fail to meet the recommended level of physical activity, highlighting a serious global public health challenge. This study approaches the issue from a public health perspective by focusing on the structural determinants of health behavior among university students. Although student health behaviors are shaped by both individual and structural factors, existing research has predominantly emphasized individual-level influences, overlooking the broader educational and systemic context. Employing a structural analysis framework, this study mapped the causal and hierarchical relationships among factors influencing student health behaviors. Data were collected through structured questionnaires administered to undergraduate and postgraduate students in Hunan Province, China. The model identifies family support as the foundational layer in the hierarchy, exerting significant influence on psychological well-being and health motivation, which in turn regulate physical activity and dietary choices. The findings underscore the critical mediating role of educational environments in amplifying the effects of family structures. Based on these insights, this study advocates for the integration of family resources into school-based health promotion interventions, such as digital platforms for parent-student communication, joint family-university health workshops, and collaborative educational health campaigns. Embedding family-oriented strategies into formal education systems may enable universities to enhance student physical and mental well-being in a more integrated and sustainable manner within a public health framework.
50. Religious and cultural perspectives on assisted reproductive technology in Ghana: A comparative analysis of traditionalist, islamic, and christian beliefs.
期刊: PLOS global public health 发表日期: 2025 链接: PubMed
摘要
The moral implications of Assisted Reproductive Technology (ART) practices often pose a dilemma for those belonging to various cultural and religious groups. However, there is a gap in scientific studies examining the perspectives of spiritual leaders and their congregations regarding ART practices in Ghana. To bridge this gap, this paper employs a qualitative approach to investigate the religious, cultural, and personal interpretations of ART practices, including gamete donation, surrogacy, and cryopreservation, among 30 members of the key religions in Ghana. The study used in-depth interviews and focus group discussions to collect data, and the results were analysed thematically. The findings show that Islamic and Christian religious figures support the use of ART to treat infertility among married couples who use their gametes. However, they do not condone the use of third-party reproductive resources, such as gamete donation, surrogacy and cryopreservation. Traditionalists, on the other hand, do not endorse the use of ART in childbearing, as they believe it interferes with natural procreation processes and challenges the role of the Creator. Cultural, religious, ethical, and personal beliefs about procreation may have influenced the views on the acceptability of ART practices among the Traditionalists. It is, therefore, important to educate the public on theology, medical technology, and infertility while respecting individuals’ religious beliefs and values.
51. Cryptosporidium spp. in wild rodents in the Poyang Lake region, China.
期刊: Parasite (Paris, France) 发表日期: 2025 链接: PubMed
摘要
Cryptosporidium spp. are zoonotic protozoan parasites that cause diarrheal disease worldwide. Rodents can harbor diverse Cryptosporidium spp. and facilitate their transmission to the environment and other hosts, including humans. However, data on Cryptosporidium infection in wild rodents in the Poyang Lake region, China’s largest freshwater lake, remain scarce. Here, we investigated Cryptosporidium spp. in 273 wild rodents collected from seven sites adjacent to villages around Poyang Lake between 2022 and 2024. The rodents were identified by cytochrome c oxidase subunit I (COI) gene sequencing as Apodemus agrarius (n = 148) and Rattus losea (n = 125). Nested PCR targeting the small subunit ribosomal RNA (SSU rRNA) gene revealed an overall Cryptosporidium spp. infection rate of 16.5% (45/273, 95% CI: 12.3-21.9%), with 20.3% (30/148, 95% CI: 14.2-27.8%) in A. agrarius and 12.0% (15/125, 95% CI: 6.9-19.0%) in R. losea. Sequence and phylogenetic analyses identified seven Cryptosporidium species/genotypes: C. apodemi, C. canis, C. muris, C. suis, C. ubiquitum, rat genotype II, and rat genotype III. Notably, the detection of four zoonotic species (C. canis, C. muris, C. suis, and C. ubiquitum) highlights the potential risk of zoonotic transmission of Cryptosporidium spp. from wild rodents to humans in this region. These findings underscore the need for systematic surveillance and control of Cryptosporidium spp. in wild rodent communities around Poyang Lake. Cryptosporidium spp. chez les rongeurs sauvages de la région du lac Poyang, en Chine. Les Cryptosporidium spp. sont des parasites protozoaires zoonotiques responsables de maladies diarrhéiques dans le monde entier. Les rongeurs peuvent héberger diverses espèces de Cryptosporidium et faciliter leur transmission à l’environnement et à d’autres hôtes, dont l’homme. Cependant, les données sur l’infection à Cryptosporidium chez les rongeurs sauvages de la région du lac Poyang, le plus grand lac d’eau douce de Chine, restent rares. Nous avons étudié Cryptosporidium spp. chez 273 rongeurs sauvages collectés dans sept sites adjacents à des villages autour du lac Poyang entre 2022 et 2024. Les rongeurs ont été identifiés par séquençage du gène de la sous-unité I de la cytochrome c oxydase (COI) comme étant Apodemus agrarius (n = 148) et Rattus losea (n = 125). La PCR imbriquée ciblant le gène de l’ARN ribosomique de la petite sous-unité (ARNr SSU) a révélé un taux d’infection global par Cryptosporidium spp. de 16,5 % (45/273, IC à 95 % : 12,3-21,9 %), avec 20,3 % (30/148, IC à 95 % : 14,2-27,8 %) chez A. agrarius et 12,0 % (15/125, IC à 95 % : 6,9-19,0 %) chez R. losea. Les analyses de séquence et phylogénétiques ont identifié sept espèces/génotypes de Cryptosporidium : C. apodemi, C. canis, C. muris, C. suis, C. ubiquitum, génotype II du rat, génotype III du rat. Notamment, la détection de quatre espèces zoonotiques (C. canis, C. muris, C. suis et C. ubiquitum) met en évidence le risque potentiel de transmission zoonotique de Cryptosporidium spp. des rongeurs sauvages à l’homme dans cette région. Ces résultats soulignent la nécessité d’une surveillance et d’un contrôle systématiques de Cryptosporidium spp. dans les communautés de rongeurs sauvages autour du lac Poyang.
52. Seasonal exchange of microsporidian parasites between native and non-native pet-traded freshwater crustaceans: Is parasite spillover favored over spillback?
期刊: Parasite (Paris, France) 发表日期: 2025 链接: PubMed
摘要
The introduction of non-native pet-traded species poses potential threats to global biodiversity, particularly in freshwater ecosystems. This study investigated the seasonal dynamics of microsporidian infections in an established feral population of cherry shrimp (Neocaridina davidi) and the coexisting populations of crustaceans, comprising both native and non-native species, inhabiting the thermal waters of the Fontcaude Park and the nearby Mosson River in southern France. Our aim was to assess the potential occurrence of spillover and/or spillback events between N. davidi and co-occurring crustaceans, as well as the influence of seasonal dynamics on these interactions. The prevalence and diversity of microsporidian parasites exhibited strong seasonal variations. Although parasites associated with the pet trade were not detected, we highlight the acquisition of native parasites by feral N. davidi, which seems to be a suitable alternative host for native host-generalist microsporidians. Our findings indicate that all prerogatives for spillback events to occur are met. Feral N. davidi may establish and survive year-round in European rivers with natural thermal regimes. Thus, human-mediated introductions can potentially alter parasite transmission dynamics in these ecosystems. Échanges saisonniers de microsporidies parasites entre crustacés d’eau douce indigènes et crustacés non indigènes commercialisés comme animaux de compagnie : le débordement parasitaire est-il favorisé par rapport à la retransmission ? L’introduction d’espèces non indigènes, commercialisées comme animaux de compagnie, constitue une menace potentielle pour la biodiversité mondiale, en particulier dans les écosystèmes d’eau douce. Cette étude examine la dynamique saisonnière des infections microsporidiennes au sein d’une population férale établie de crevettes de David (Neocaridina davidi) et des populations coexistantes de crustacés, indigènes et non indigènes, vivant dans les eaux thermales du parc de Fontcaude et de la Mosson, dans le sud de la France. Notre objectif était d’évaluer la survenue potentielle de débordement parasitaire et/ou de retransmission parasitaire entre N. davidi et les crustacés coexistants, ainsi que l’influence de la dynamique saisonnière sur ces interactions. La prévalence et la diversité des microsporidies parasites ont montré de fortes variations saisonnières. Bien que les parasites associés au commerce des animaux de compagnie n’aient pas été détectés, nous soulignons l’acquisition de parasites indigènes par N. davidi de la population férale, qui semble être un hôte alternatif approprié pour les microsporidies généralistes indigènes. Nos résultats indiquent que toutes les conditions sont réunies pour que des événements de retransmission se produisent. Neocaridina davidi pourrait s’établir et survivre toute l’année dans les rivières européennes à régimes thermiques naturels. Ainsi, les introductions d’origine humaine peuvent potentiellement modifier la dynamique de transmission des parasites dans ces écosystèmes.
53. Lipid droplet distribution quantification method based on lipid droplet detection by constrained reinforcement learning.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
We previously proposed the lipid droplet detection by reinforcement learning (LiDRL) method using a limited dataset of pathological images. The method automatically detects lipid droplets using reinforcement learning to optimize filter combinations based on their size and grayscale contrast. In this study, we aimed to detect lipid droplets reliably and analyze their distribution patterns across pathological tissue images. For this purpose, we improved the environmental and agent-side functions in LiDRL to obtain a revised method. These improvements increased the stability and robustness of the system, enabling consistent extraction of lipid droplets of similar sizes across all rank levels in the pathological tissue images. We quantified the lipid droplet distribution using average probability density and entropy and visualized it as a heat map. This analysis facilitates the extraction of lipid droplet characteristics that could serve as indicators of liver disease.
54. Social determinants of self-medication with leftover antibiotics in Lebanese households: A cross-sectional study.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Self-medication with leftover antibiotics (LA) is a global health crisis, particularly in contexts of economic and political instability. This study examines the social determinants of health (SDOH) influencing LA use among Lebanese households, focusing on how individuals are born, grow, live, and work. A cross-sectional study was conducted among 368 Lebanese adults to collect data on socio-demographic characteristics, self-medication practices related to LA, and key SDOH such as socioeconomic status (SES), perceived discrimination in medical settings (DMS), political and economic instability, drug shortages, and trusted sources of health information. Data were analyzed using bivariate tests and multivariable logistic regression. Bivariate analysis showed that LA use was significantly associated with male gender (45.0% vs. 33.3%, p = 0.024), lower educational levels (58.7% vs. 35.1%, p = 0.002), presence of chronic disease (54.7% vs. 32.2%, p < 0.001), older age (p = 0.028), and a higher household crowding index (p = 0.018). LA use was also more prevalent among participants impacted by political instability, economic crisis, and drug shortages (all p < 0.001). In multivariable logistic regression, chronic disease (OR = 2.711, p = 0.002), economic crisis (OR = 2.013, p < 0.001), and prior experience with the same illness (OR = 4.085, p < 0.001) were identified as significant predictors for LA use. These findings show the critical role of socio-economic instability, healthcare access challenges, and experiential factors as key SDOH driving LA practices. The study highlights the urgent need for multi-sectoral interventions addressing economic hardship, improving healthcare access, and enhancing public awareness to mitigate LA misuse and its contribution to antimicrobial resistance in Lebanon.
55. Climate change, disability, and water, sanitation and hygiene: A scoping review of evidence and interventions in low and middle-income countries.
期刊: PLOS global public health 发表日期: 2025 链接: PubMed
摘要
Climate hazards, including extreme weather events, undermine essential water, sanitation and hygiene (WASH) services, exacerbating health disparities in people with disabilities. Despite this, WASH policies and adaptation strategies often overlook the need for disability inclusive measures. The scoping review objectives are to 1) map the evidence on how climate risks affect WASH services and coping strategies in low-and middle-income countries, with a particular focus on people with disabilities; and 2) assess evidence for the effectiveness of climate-resilient WASH interventions, emphasising their impact on people with disabilities. Our review identified substantial data on women and girls, so the results reflect binary gender considerations. A systematic search of nine databases, including CINAHL Complete, Global Health, GreenFILE, and MEDLINE via PubMed, was conducted to identify peer-reviewed and grey literature using relevant keywords related to extreme weather and climate hazards, WASH (including menstrual health), disability, and evaluations. We included studies in English, published between January 1, 2000 and December 31, 2023. Data were extracted and analysed thematically. Twenty-two studies met the inclusion criteria. Only two papers evaluated climate-resilient WASH interventions (rainwater harvesting), and neither considered disability. Most papers examined people’s self-reported health impacts and experiences affected by drought-related water insecurity or WASH infrastructure damage due to extreme weather events. Data on the experiences of persons with disabilities were only included in two papers. They highlighted that persons with disabilities are disproportionately disadvantaged by climate-related damage to WASH infrastructure and emphasised the importance of social capital and social networks in supporting them when access to water is limited. Extreme weather events disrupt WASH services, yet evidence of the experiences and coping strategies of persons with disabilities remains extremely limited. This is a barrier to developing disability inclusive adaptation strategies. Evaluating climate-resilient WASH interventions is essential to enhance resilience and health equity for persons with disabilities.
56. Seasonal variation in egg nutrient composition under a pasture-based layer hen system: Implications for sustainable agriculture.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Sustainability in poultry production emphasizes systems that promote environmental health, animal welfare, and the potential to produce a more nutrient dense product. Pasture based poultry systems align with these sustainability goals by supporting soil fertility, biodiversity, and more natural behaviors. Access to pasture allows chickens to consume a diverse range of plants and insects, potentially enhancing the nutritional value of their eggs. However, environmental variability across the grazing season may influence egg nutrient profiles, impacting both nutritional quality and system resilience. This study evaluated how seasonal changes in forage quality, soil composition, and climate affect the nutrient profile of eggs produced under a regenerative, pasture-based system in Southern Ohio. Monthly collections of forage (n = 3) and eggs (n = 24, pooled into 12 replicates) occurred from May to December. Fatty acid composition was assessed using gas chromatography-mass spectrometry, while carotenoid and phenolic levels were measured colorimetrically. Vitamin and mineral content were analyzed through liquid chromatography and Inductively Coupled Plasma Optical Emission Spectroscopy. Pasture quality, assessed by total digestible nutrients (TDN), peaked in October. Egg protein quality met USDA “Grade AA” standards every month except August (p > 0.001). The highest yolk pigmentation score was recorded in December (9.5 ± 1.3; p < 0.001). Vitamin A levels were significantly greater in late summer (p < 0.001), while vitamin E gradually increased across the season, reaching its highest value in November (118.1 ± 24.0 µg/g fresh yolk; p < 0.001). Carotenoid concentrations were elevated in mid-summer and late autumn (p < 0.001). Total omega-3 fatty acids were significantly higher in September and October than in mid-summer and late fall, while the n-6:n-3 ratio was lowest in early summer, and fall compared to July (p < 0.001). Sparse partial least squares discriminant and random forest analyses demonstrated that eggs produced from September to November contained higher levels of vitamins A and E, greater essential omega-3 fatty acids, and a more favorable n-6:n-3 balance than eggs from other months. These findings highlight the need to account for seasonal variability in pasture-based systems and suggest targeted management practices could enhance year-round nutritional quality, supporting both consumer health and sustainable food production.